Extending the Indications of Flow Diversion to Small, Unruptured, Saccular Aneurysms of the Anterior Circulation

Abstract

The University Institutional Review Board approved the study protocol. Forty consecutive patients with unruptured, previously untreated, small (<10 mm) aneurysms treated with PED (2011PED ( -2013 at our institution were identified from a prospectively maintained database. Patients treated with PED and adjunctive coiling were not included in the analysis. Every patient treated with the PED was matched to 4 control patients treated with stent-assisted coiling (2004-2011) based on patient age, sex, aneurysm location, and aneurysm size. Patients were excluded from this study if the aneurysm had previously ruptured, was located in the posterior circulation, or was fusiform in morphology.Patients undergoing PED therapy received 75 mg/d of clopidogrel and 81 mg/d of aspirin for 10 days before the intervention. Platelet Background and Purpose-Flow diverters are currently indicated for treatment of large and complex intracranial aneurysms.The purpose of this study was to determine whether the indications of flow diversion can be safely extended to unruptured, small, saccular aneurysms (<10 mm) of the anterior circulation. Methods-Forty patients treated with the pipeline embolization device (PED) were matched in a 1:4 fashion with 160 patients treated with stent-assisted coiling based on patient age, sex, aneurysm location, and aneurysm size. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results-The rate of periprocedural complications was 5% in the PED group and 3% in the stent-coil group (P=0.7). In multivariable analysis, increasing age was the only predictor of complications. At follow-up, a higher proportion of aneurysms treated with PED (80%) achieved complete obliteration compared with stent-coiled aneurysms (70%) but the difference did not reach statistical significance (P=0.2). In multivariable analysis, increasing aneurysm size and aneurysm location were predictors of nonocclusion. The rate of favorable outcome (modified Rankin Scale, 0-2 and modified Rankin Scale, 0-1) was similar in the PED group and the coil group. Conclusions-The PED was associated with similar periprocedural risks, clinical outcomes, and angiographic results compared with stent-assisted coiling. These findings suggest that the indications of PED can be safely extended to small intracranial aneurysms that are amenable to conventional endovascular techniques. Larger studies with long-term follow-up are necessary to determine the optimal treatment that leads to the highest rate of obliteration and best clinical outcomes. (Stroke. 2014;45:54-58.)

The Choice of the Treatment Method for Cerebral Aneurysms of Different Locations in the Era of Advanced Endovascular Technologies: A Meta-Analysis

“…Улучшения касаются как анатомических результатов полной окклюзии ЦА при повторных ангиограммах, так и показателей трав-матичности и летальности при операциях [38]. Общее количество интраоперационных осложнений эндова-скулярного койлинга находится на уровне 3,7-5,3%, интраоперационной смертности -1,1-1,5% [39], что соответствует показателям открытой операции -4-11 и 1-3%, соответственно.…”

Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

“…5,9,10,16 The latter approach has been increasingly used to treat large and giant aneurysms of the internal carotid artery, and recent studies have shown flow diverters to have a safety profile comparable to that of traditional endovascular techniques. 9,10,16 Limitations This study is limited by its retrospective design. Many aneurysms treated with coil therapy during the study period were not included in the analysis because the patients did not have available short-term and longterm follow-up DSA images.…”

Current Trends and Results of Endovascular Treatment of Unruptured Intracranial Aneurysms at a Single Institution in the Flow-Diverter Era

“…The rate of complete occlusion in the FD group with at least 6 months of follow-up of 64.4% is lower than that in other flow-diverter studies; however, the low rate of retreatment (6%) is in line with those previously reported. [24][25][26][27][28] In the Pipeline for Uncoilable or Failed Aneurysms Study, 24 the rate of complete occlusion was 82% at 6 months and 86% at 12 months. Likewise, in a large single-center consecutive series of 54 patients, Lylyk et al 25 found high rates of completeaneurysm occlusion of 93% and 96% at 6 and 12 months, respectively.…”